Poor adherence to treatments of chronic diseases is a worldwide problem of striking magnitude. Adherence to long-term therapy for chronic illnesses in developed countries averages at 50%*. This represents a dreadful state of affairs for people with chronic diseases.
According to the World Health Organisation, “Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments.”*
Yet the mere mention of adherence can elicit a groan from anybody who has tried to improve it. And there is no denying it is very difficult. But if a pharmaceutical company can bring a molecule through 12 years of clinical development and commercialisation, surely we can do a better job of adherence. Because one of those things is actual science carried out in a lab, the other is just better design and communication. If a company can invest $100 million dollars bringing a product from lab to patient, surely it can invest half a percent in second-to-none support materials that help patients take the treatment correctly.
We need to collectively set a more ambitious goal for patient materials. At McCann Health Nordic, we see the job of patient and HCP support materials as intervening when negative behaviours and habits need managing.
To intervene we must identify the right point of intervention (before the barriers are reached). We also have to move away from a mind-set of supplying information. We must stop kidding ourselves that awareness leads to behavioural change. It doesn’t. Every touch point requires a meaningful interaction. To do that we need to apply design communication that drives action over words that merely deliver information.
Another thing that makes adherence difficult is that it is often considered a single thing to be achieved. In reality, adherence is the outcome of many, smaller successes. To even discuss adherence, we need to understand the entire patient journey, and then break it up into logical, manageable sections. To highlight the closeness of the opportunity, this article will focus on how to deliver the very best treatment initiation. If we can’t deliver a strong start, we don’t stand much of a chance at long-term adherence.
• Patient obligation: can we really ask patients to ingest or inject medicine without providing the support they need to achieve the strongest possible start?
• Payer obligation: can we really ask for a premium price without providing the tools that help patients take the medication correctly, at the correct dose, that will get them on the way to target and thus reduce long-term adverse costs?
• Business obligation: the value of a patient who takes half the dose and drops our after 12 months, vs a patient who takes the correct dose throughout a long-term treatment duration are clearly two different things. High dropout rates could be a great opportunity.
Most chronic disease therapies run a ‘start’ and ‘switch’ strategy. Doing this, knowing up to 50% of those starts might dropout within 12 months, is tantamount to a catch and release strategy. The pharmaceutical industry would do well to study modern telecoms and web provider companies. Fundamentally different industries, yes, but these industries have gone from being famously inept at customer services, to being built upon customer retention. They have done this by moving beyond the value of their product and targeting the lifetime value of their customers. The ‘customer lifetime value’ business is very different from the product value business.
If capturing the lifetime value of patients was a top priority budget allocation would look very different today. Sales cycle toolboxes updates would have a different output and strong starts leading to improved adherence would already be a reality. If the industry took a hard look at the revenue left on the table by not capturing lifetime value, products and services would be vastly different.
We can start by stating very clearly what it isn’t. It isn’t a call centre or an online panel of HCPs ready to answer questions and offer support. It isn’t personalised treatment education. For the most part it’s simply doing a better job of what we already do. It’s user centric design even if the tool is analogue. It's gamifying on paper. It's 30 second answers to big problems. It’s co-creation between HCPs, patients and industry. It’s understanding that the Instructions for Use materials require continual simplifying, testing and refining (and probably a bigger font). It’s deciding not to invest €50,000 on a new layout for a detail aid that has no new data. Instead we should look at how we can do more to help patients manage their disease with their prescribed treatments. It’s a decision to just do it better.
We believe a ‘Strong Start’ platform will help patients find their feet in an otherwise confusing new reality. We believe it will increase the number of patients getting to target. We also believe it will reduce the time it takes to get there. When physicians have these real-world experiences we will be able to better drive loyalty and influence prescribing habits.
Physicians are creatures of habit. Our best opportunity to break those habits does not exist with clinical data, or really with real world evidence. The best way to change a physician’s habits is with Real World Experience, meaning they see positive outcomes in their own patients. They need to see more of their patients sticking the the treatment regimen and hitting targets.
The purpose of a 'strong start' is to help more patients stick with the prescribed dose targets. It's to ensure they better understood how to avoid adverse risks. Ultimately, it's about getting more patients to target? These are the values that make for a positive Real World Experience for HCP and patient. They are also the values that increase unit sals and patient retention.
How could market share be improved if patient dropout was reduced by just 5%? Or if we could retain patients for the treatment duration? Yes, adherence is hard, but the rewards are also significant.
When we consider all these things we believe Strong Starts are an amazing opportunity to deliver better patient outcomes and better business results. But the value of Strong Starts increases as we look further down the line. If payment for outcome contracts become commonplace, Strong Starts and adherence won’t just be essential to our business, they will become the business.
Together with our clients, McCann Health Nordic is stepping up to the adherance challenge. Our ‘Strong Starts’ platform enables us to identify the opportunity and the point of intervention. Our design communication techniques work to better manage the behaviours that negatively impact treatment outcomes.
To hear more about how to improve adherence with our ‘Strong Starts’ platform, contact Alan Emmins on email@example.com